16 December 2021 

Opioid agonist treatment, commonly methadone or buprenorphine, for people dependent on heroin or other opioid drugs has an important role to play in suicide prevention, according to University of Bristol-led research published in The Lancet Psychiatry.

Methadone being passed into the hands of service user

People who are dependent on opioid drugs are at increased risk of suicide and self-harm. The researchers analysed the healthcare records of over 8,000 adults prescribed methadone or buprenorphine in primary care in England to see if there were particular times during and after drug treatment when they were most at risk.

They found that these patients were, overall, seven and a half times more likely to die by suicide than the general population. In addition, they found that in the first month after treatment stopped, they were four times more likely to die by suicide and more than twice as likely to be hospitalised for self-harm, compared to during a stable period on drug treatment.

Dr Prianka Padmanathan, Medical Research Council-funded Clinical Research Fellow, Population Health Sciences at the University of Bristol and lead author of the study, said: “The findings of this study emphasise that people with opioid dependence are much more likely to die by suicide compared with the general population. Opioid agonist treatment is often stigmatised and has been under-funded. This research strengthens the case for valuing initiatives that improve engagement with treatment and provide psychological support, particularly at the point at which treatment ends or is stopped.”

Professor Matt Hickman, senior author, from the National Institute for Health Research (NIHR) Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, said: “The UK has one of the highest rates of drug-related deaths in Europe, and these deaths most commonly involve opiates such as heroin. However, suicide prevention in people dependent on opiates is a neglected area, which is important for reducing drug-related harm, suicides, and premature death. The first few weeks after treatment cessation is critical a period to re-engage people so as to prevent overdose and also, as this study shows, suicide.”

Paper: Self-harm and suicide during and after opiate agonist treatment: a cohort study of primary care patients in England by Prianka Padmanathan et al. Published in The Lancet Psychiatry. December 2021.

Commentary: Opiate agonist treatment for suicide prevention by Paul Nestadt and Alison Athey. Published in The Lancet Psychiatry. December 2021.

Further information 

About the NIHR Health Protection Research Unit [HPRU] in Behavioural Science and Evaluation at the University of Bristol

The NIHR HPRU in Behavioural Science and Evaluation at University of Bristol is one of 14 HPRUs across England, part of a £58.7 million investment by the NIHR to protect the health of the nation.

The NIHR HPRU in Behavioural Science and Evaluation is a partnership between the UK Health Security Agency (UKHSA) and University of Bristol, in collaboration with MRC Biostatistics Research Unit at the University of Cambridge and University of the West of England.

Each NIHR HPRU undertakes high quality research that is used by UKHSA to keep the public safe from current and emerging public health threats.

About the NIHR

The National Institute for Health and Care Research (NIHR) is the nation’s largest funder of health and care research. The NIHR:

  • funds, supports and delivers high quality research that benefits the NHS, public health and social care
  • engages and involves patients, carers and the public in order to improve the reach, quality and impact of research
  • attracts, trains and supports the best researchers to tackle the complex health and care challenges of the future
  • invests in world-class infrastructure and a skilled delivery workforce to translate discoveries into improved treatments and services
  • partners with other public funders, charities and industry to maximise the value of research to patients and the economy.

The NIHR was established in 2006 to improve the health and wealth of the nation through research, and is funded by the Department of Health and Social Care. In addition to its national role, the NIHR supports applied health research for the direct and primary benefit of people in low- and middle-income countries, using UK aid from the UK government.